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. 2022 Jan 4;79(1):18-32.
doi: 10.1016/j.jacc.2021.10.031.

Reintervention and Survival After Transcatheter Pulmonary Valve Replacement

Doff B McElhinney  1 , Yulin Zhang  2 , Daniel S Levi  3 , Stanimir Georgiev  4 , Elżbieta Katarzyna Biernacka  5 , Bryan H Goldstein  6 , Shabana Shahanavaz  7 , Athar M Qureshi  8 , Allison K Cabalka  9 , Holly Bauser-Heaton  10 , Alejandro J Torres  11 , Brian H Morray  12 , Aimee K Armstrong  13 , Oscar Millan-Iturbe  14 , Lynn F Peng  2 , Jamil A Aboulhosn  15 , Witold Rużyłło  5 , Felix Berger  16 , Lars Sondergaard  14 , Dietmar Schranz  17 , John P Cheatham  13 , Thomas K Jones  12 , Peter Ewert  4 , Stephan Schubert  16
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Free article

Reintervention and Survival After Transcatheter Pulmonary Valve Replacement

Doff B McElhinney et al. J Am Coll Cardiol. .
Free article

Abstract

Background: Transcatheter pulmonary valve (TPV) replacement (TPVR) has become the standard therapy for postoperative pulmonary outflow tract dysfunction in patients with a prosthetic conduit/valve, but there is limited information about risk factors for death or reintervention after this procedure.

Objectives: This study sought to evaluate mid- and long-term outcomes after TPVR in a large multicenter cohort.

Methods: International registry focused on time-related outcomes after TPVR.

Results: Investigators submitted data for 2,476 patients who underwent TPVR and were followed up for 8,475 patient-years. A total of 95 patients died after TPVR, most commonly from heart failure (n = 24). The cumulative incidence of death was 8.9% (95% CI: 6.9%-11.5%) 8 years after TPVR. On multivariable analysis, age at TPVR (HR: 1.04 per year; 95% CI: 1.03-1.06 per year; P < 0.001), a prosthetic valve in other positions (HR: 2.1; 95% CI: 1.2-3.7; P = 0.014), and an existing transvenous pacemaker/implantable cardioverter-defibrillator (HR: 2.1; 95% CI: 1.3-3.4; P = 0.004) were associated with death. A total of 258 patients underwent TPV reintervention. At 8 years, the cumulative incidence of any TPV reintervention was 25.1% (95% CI: 21.8%-28.5%) and of surgical TPV reintervention was 14.4% (95% CI: 11.9%-17.2%). Risk factors for surgical reintervention included age (0.95 per year [95% CI: 0.93-0.97 per year]; P < 0.001), prior endocarditis (2.5 [95% CI: 1.4-4.3]; P = 0.001), TPVR into a stented bioprosthetic valve (1.7 [95% CI: 1.2-2.5]; P = 0.007), and postimplant gradient (1.4 per 10 mm Hg [95% CI: 1.2-1.7 per 10 mm Hg]: P < 0.001).

Conclusions: These findings support the conclusion that survival and freedom from reintervention or surgery after TPVR are generally comparable to outcomes of surgical conduit/valve replacement across a wide age range.

Keywords: Ross procedure; pediatric; pulmonary atresia; pulmonary valve; tetralogy of Fallot.

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Conflict of interest statement

Funding Support and Author Disclosures Dr McElhinney has served as a consultant for Medtronic. Dr Levi has served as a consultant for Edwards and Medtronic. Dr Goldstein has served as a consultant for Medtronic. Dr Shahanavaz has served as a consultant for Edwards and Medtronic. Dr Qureshi has served as a consultant for Edwards, Medtronic, W.L. Gore and Associates, and Abiomed Inc. Dr Cabalka has served as a consultant for Medtronic. Dr Torres has served as a proctor for Edwards. Dr Morray has served as a consultant for Medtronic. Dr Armstrong has served as a consultant for Edwards and Medtronic; and has received research grants from Edwards. Dr Aboulhosn has served as a consultant for Edwards and Medtronic; and has received research grants from Edwards. Dr Berger has served as a consultant for Medtronic. Dr Sondergaard has served as a consultant for and received research grants from Edwards and Medtronic. Dr Schranz has served as a consultant for Medtronic. Dr Jones has served as a consultant for and received research grants from Edwards and Medtronic. Dr Cheatham has served as a consultant for Medtronic and NuMED. Dr Schubert has served as a proctor for Abbott, Edwards, Gore, Lifetech, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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